- CVS Health (Trenton, NJ)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical experience in acute… more
- CVS Health (Jefferson City, MO)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. ... external constituents in the coordination and administration of the utilization /benefit management function. * Typical office working...residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical experience in acute… more
- Insight Global (New York, NY)
- …RN License for the state the consultant resides in - 4-5 years of Remote Utilization Management experience at Payors, inpatient or outpatient - ... Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance… more
- CVS Health (Columbus, OH)
- …work the following schedule:** **Monday-Friday 8:00am-4:30pm EST.** **Position Summary** As a Utilization Management Nurse Consultant, you will utilize ... and time management skills required - Experience in healthcare utilization management , critical care, emergency department, or case management… more
- CVS Health (Baton Rouge, LA)
- …of training will require 100% participation Monday-Friday, 8am-5pm upon hire.** As a Utilization Management Nurse Consultant, you will utilize clinical ... Qualifications** + 5+ years of clinical experience + 1+ year(s) of utilization management , concurrent review and/or prior authorization experience + 5+… more
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… more
- Humana (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...based on a business need) + This is a remote position **Scheduled Weekly Hours** 40 **Pay Range** The… more
- Elevance Health (Tampa, FL)
- …of Florida. + Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; or any combination of education ... Senior RN Utilization Review/ Management (Acute InPatient) JR116937 **Location:**...Friday. **2 Holidays** per year and **occasional** weekends. The ** Nurse Medical Management Sr** serves as **team… more
- Actalent (Santa Barbara, CA)
- Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a contract basis! Opportunity to gain experience ... 3-month contract + Medi-Cal Experience + Utilization Management WHAT'S IN IT FOR YOU: + Remote...with a leading healthcare organization Description: The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse … more
- CVS Health (Lansing, MI)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with ... care more personal, convenient and affordable. **Position Summary** _Utilization Management is a 24/7 operation and the work schedule...holidays, and evening hours._ This will be a full-time remote role. Schedule is Monday through Friday, 8am to… more
- CVS Health (New Albany, OH)
- …training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for telephonically ... assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Molina Healthcare (Seattle, WA)
- …Experience with the adult behavioral health system in Washington State and** ** Utilization Management experience is highly preferred.** **_Further details to be ... discussed during our interview process._** ** Remote position** **Work schedule M-F 8:30 AM to 5:00...the following: + Completion of an accredited Licensed Vocational Nurse (LVN) + Licensed Practical Nurse (LPN)… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- Summary The Patient Flow Utilization Management / Utilization Review Consultant RN functions with advanced knowledge and skills to provide clinical ... with a collaborative, inter-disciplinary practice setting. Responsibilities The Patient Flow Utilization Management / Utilization Review Consultant RN is… more
- Amergis (Los Angeles, CA)
- …+ Audits medical records and monitors performance measures for health care risk management , sentinel events and trends + Oversees and monitors the development and ... + Performs other duties as assigned/necessary Minimum Requirements: + Registered Nurse or Licensed Practical Nursing license required + Certified Professional in… more
- Centene Corporation (Madison, WI)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...New Jersey regulations for Nursing **.** **This is a remote , night shift position. The schedule for this role… more
- Dignity Health (Bakersfield, CA)
- …Arizona, with a clear and current CA RN license.** **Position Summary:** The Director of Utilization Management is the senior lead over the utilization ... **Overview** This position is remote within California, Nevada or Arizona, with a...UM Director is also responsible for the oversight of utilization management auditing, both internal and external,… more
- Sanford Health (Fargo, ND)
- …care continuum for assigned patient populations. This position primarily focuses on Utilization Management activities such as: * Evaluate medical necessity, ... reviews using MCG guidelines and/or InterQual criteria * Prompt and effective management of payer denials and appeals * Collaboration and consultation with secondary… more
- AdventHealth (Altamonte Springs, FL)
- …The Senior Manager of Utilization will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes. The Senior Manager of ... (Travel** **across all Well 65 practices and will be remote when not at a practice)** **The role you'll...support, training and guidance to the RN on care management duties/assignments. The Senior Manager of Utilization … more
- SSM Health (WI)
- …Shift (United States of America) **Job Type:** Employee **Department:** 8746030033 Sys Utilization Management **Scheduled Weekly Hours:** 40 _SSM Health is an ... WI- REMOTE **Worker Type:** Regular **Job Highlights:** + **Department:** Utilization Review + **Schedule:** Full Time, Day Shift, 8:30am-5:00pm; every 3rd… more